Healthcare Provider Details

I. General information

NPI: 1578380267
Provider Name (Legal Business Name): TRISHA NICOLE WILLISON LPC CANDIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 E 81ST ST STE 4460
TULSA OK
74137-4251
US

IV. Provider business mailing address

27421 E 108TH PL S
COWETA OK
74429-9013
US

V. Phone/Fax

Practice location:
  • Phone: 918-600-2966
  • Fax:
Mailing address:
  • Phone: 918-698-0451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: